Efficacy Of Bedside Cannulation For Percutaneous Ventricular Assist Devices

ABSTRACT: Percutaneous ventricular assist devices (pVAD) have become a mainstay in the treatment of cardiogenic shock, but their use is limited by the need for specialized staff, equipment, and facilities which may not be readily available. Moreover, the COVID-19 pandemic has further limited such interventions due to possible staff exposure, need for additional protective personal equipment, and efforts to limit patient transport. We have implemented a bedside intensive care unit pVAD cannulation strategy using a mobile fluoroscopy arm with transesophageal echocardiogram to guide placement. Table 1 shows characteristics and outcomes of 6 patients cannulated with a percutaneous right or left ventricular assist device (pRVAD or pLVAD). All patients were previously supported with Veno-Arterial or Veno-Venous Extracorporeal Membrane Oxygenation (VA or VV ECMO). 3 patients had pLVAD placed for worsening LV distention after VA-ECMO initiation. 3 patients had pRVAD placed for severe RV failure in the setting of severe COVID infection and hypoxia. In all cases pVADs were successfully placed and patients anticoagulated with IV heparin afterwards. Although one patient with pLVAD placement had an access site compartment syndrome that required fasciotomy, we were able to maintain pLVAD support. Hemodynamic data showed that each patient was supported by their pVAD; unfortunately, 4 of the 6 passed away due to their underlying condition. CONCLUSIONS: Bedside placement of pVAD can be performed safely and effectively. Mortality remains high, though this was unrelated to device function in our patients. Our approach limits the need for specialized staff and facilities and may allow for more rapid initiation of mechanical circulatory support while decreasing healthcare costs.